mcgrath study guide 1 Flashcards
General concepts and care of older adults
- proper discharge teaching (FOLLOW UP CARE)
- we want a person with chronic illness to be able to transition from the hospital or wherever they are to their home
- patient can manage their own symptoms (disease management) cus we dont want patients with chronic illness to keep coming in and out the hospital
WATCH OUT FOR CONFUSION AND DEMENTIA BUT THEY ARE NOT NROMAL EFFECTS OF AGING
what does chronic illness require
- people learn to live with symptoms and disabilities
- come to terms with identity change
- manage regimens necessary to keep symptoms under control
cause is unknown and unpredictable
Approaches by the nurse for chronically ill patient
- explain to the patient the characteristics of their chronic illness
- want them to be able to adjust to their chronic illness
- WE WANT THEM TO MANAGE THEIR DISEASE
- be aware of FATIGUE AND DEPRESSION
Medication issues for the elderly
Sometimes error happens cus
- decreased vision
- forgetfulness
- using other peoples medications
- use of over the counter meds OTC
- ASK other than your OTC medication, what other meds are you taking
- we want them to take the medication slowly, right dose
- use pill box
- lack of money to buy meds
- side effects
- dont comprehend the instructions (take by day or night)
pretrajectory phases
they just at risk for it but they dont have it
stable phase of chronic illness
NO SYMPTOMS
symptoms and disability are managed
unstable phase (CRISIS) of chronic illness
- look at the blood pressure (HIGH? LOW, KEEP CHANGING??)
- look at the blood sugar
- exacerbation of symptoms
- development of complications
- reactivation of illness in remission (flareup)
What are the medicare criteria for Home care?
MARY HANSON IS UGLY RUDE CUNT
○ doctor orders (Mary ○ homebound status (Hanson ○ intermittent skilled nursing care (catherization etc) (Is ○ unstable condition (Ugly ○ reasonable and measurable goals (Rude ○ certified agency (Cunt
role of the nurse is not to be doing ADLs with the patient. that can be done by companion or nurse aide
Home Care discharge planning
- can it be managed at home?
- may need physical therapy (PT)
- may need occupational therapy (OT)
- how many visits can they get
- is their illness unstable, but manageable, not requiring hospital admission
how we know if the patient is ready to be discharged from home care?
look at their condition
- if the patient is still unstable? = YOU CAN GET THEM MORE VISITS BASED ON THEIR DOCUMENTATION
THEIR CONDITION IS WHAT CAN GET THEM MORE VISITS
Assessment of home care patient
- safe for the patient, family, attending nurse
- INFECTION CONTROL
- DISASTER PLANNING
- CONFIDENTIALITY
teaching a patient in homecare
- are they ready
- are they motivated
- how much do they know about their diagnosis
wanna know where you starting from
- can you tell me about your diabeties? cus you want to know what else needs to be taught to the patient
home care bag Technique
- Keep it sanitary (not on floor, tripping hazard)
- YOURE A GUES IN THEIR HOME. ASK BEFORE YOU DO ANYTHING
- needles are secured
- can i sit? can i put my bag on the table? where can i wash my hands
BIGGEST FEAR OF HOME CARE FOR NURSES
- transmission of organisms to the patient
Primary emphasis of rehab
- make sure the patient is motivated
- plan with patient and SMART GOALS
- physical therapy, occupational therapy
FOCUS MAIN ABILITIES
- focus on the functional parts ESPECIALLY IF A PATIENT HAS A RIGHT SIDE PARALYSIS, FOCUS ON THE LEFT SIDE CUS WE WANT TO MAKE THE LEFT SIDE STRONGER!!
Interventions for hospice patient who has difficulty breathing (SLOW DOWN THEIR BREATHING)
- MAK SURE THEY ARE NOT FLAT!
- elevated atleast 30 degree
- if alert and oriented, do some relaxation techniques
- ADMINISTER PALLIATIVE SEDATION ( can calm down their breathing )
- that can cause respiratory
patient breathing quickly then they stop breating. On and off pattern = CHEYNE STOKE
- CHEYNE STOKES & DEATH RATTLE = go over transition, oral thrush (nystatin flush), kennedy ulcer- nonblanchable CLOSED SORE
Patient concerns in hospice
- want them to die with COMFORT DIGNITY AND RESPECT
advantages of a Central Venous Access Device (VAD) rather than a peripheral line
- immediate access
- reduced venipunctures
- decreased risk of extravasation ( from vein to tissue)
disadvantages of a Central Venous Access Device (VAD)
- increased risk of systemic infection because its a central line goin to the heart
- INVASIVE PROCEDURE
complications of a Central Venous Access Device (VAD)
- occlusion of the catheter =
- embolism/clot = entry of air, catheter breaks, disloged thrombus
- infection
- pneumothorax
what happens when they inserting a Central VAD and the patient starts to complain of chest pain and shortness of breath
- check (ausculate) their lungs to see whats happen? maybe you punctured their lung?
burns to face and neck
very serious why?
- gonna have difficulty breathing
- they gonna have edema
- DONT LIE THEM FLAT. we want them to be able to
- 100% oxygen (non rebreather mask)
clothes on? REMOVE THEM!!
patient has a burn and need a dressing change, what do we do?
- give them pain medications
- hydropmorphone, dilaudid, morphine
Fluid resuscitation of burn. what do we monitor the patient for
- vital signs and I&O
TYPICALLY OUTPUT!!!
USE CHAMBER CUS YOU WANNA RECORD
what if a patient has respiratory distress from a burn. what assessments?
- sputum black
- dry cough
- singed nasal hair
- hoarseness
- painful swallowing
- darkened and nasal membrane (SHOULD BE PINK)
Rule of nines
- burn percentage to worry about = 30 and higher
- problem they get when its 30 and up is fluid problems EDEMA and prone to other complications
- anasarca = TOTAL BODY EDEMA from another condition maybe kidney?
